PhD Graduates – 2023

Background: The Agency for Healthcare Quality and Safety has recognized missed care as a significant threat to healthcare quality and patient safety. The incidence of Missed Care is high internationally. The effect of the synergistic relationships among organizational (i.e., practice environment support, RN workload, patient-to-RN staffing ratios) and nurse characteristics, (i.e., experience level, education level, sleep hours, consecutive work shifts) and occupational fatigue
types (i.e., chronic fatigue, acute fatigue, and inter-shift recovery) on the incidence of missed
care at night is not well known.

Objectives: Guided by the Integrated Model of Abnormal Work Schedules, Organizational and Nurse Characteristics, Occupational Fatigue, and Missed Care the aims of this study were to examine (1) the individual, and independent effects of organizational characteristics, and occupational fatigue types on the incidence of missed care in registered nurses (RN) working in acute care hospitals at night; and (2) the moderating effects of organizational characteristics, and nurse characteristics on the relationship between occupational fatigue types and missed care at night.

Methods: This dissertation employed a quantitative, cross-sectional Design. A publicly available roster of registered nurses actively licensed to practice in New Jersey was used to recruit participants for this study. The data were analyzed using SPSS software. Registered nurses completed an online questionnaire which included (i.e., age, gender, race, ethnicity, marital
status, employment status, hours worked per week, years of experience, level of education, consecutive shifts worked per week, number of hours slept between shifts, overall sleep quality, number of adolescent/child dependents, number of elderly/adult dependents, and care of COVID-19 patients on their last shift worked). Reliable and valid instruments including, the Tasks Undone-12 (TU-12) scale, the Practice Environment Scale of Nurse Work Index (PESNWI), the Individualized Workload Perception Scale-Revised (IPWS_R) subscale, a single item staffing question, and the Occupational Fatigue and Exhaustion Recovery Scale (OFER-15) were used in this study.

Results: Descriptive statistics, Pearson’s correlation, multiple linear regression, and simple moderation analysis were employed. Individual predictors of missed care at night were practice environment support, RN workload, patient-to-RN staffing ratios, chronic fatigue, and inter-shift recovery. Acute fatigue did not individually predict missed care at night. Multiple regression analysis revealed patient-to-RN staffing ratios and chronic fatigue to be predictors of missed care at night. Moderation analysis revealed that (1) acute fatigue and missed care was dependent on a nurses experience level, (2) inter-shift recovery and missed care was dependent on a nurses experience level, and sleep hours between shifts. Simple slope analysis revealed that nurses with 5 or more years of experience, and high acute fatigue had higher levels of missed care. Conversely, nurses with 5 or more years of experience, and 7 or more hours of sleep between shifts had lower levels of missed care.
Conclusion: Implications of this study informs policies for safe nursing practice and patient safety at night.

Latinos have been disproportionately affected by the coronavirus pandemic (COVID-19) compared to non-Latino Whites, as evidenced by confirmed cases, hospitalization rates, and related deaths. Moreover, recent COVID data indicate that racial and ethnic minorities are disproportionately experiencing worse mental health outcomes during this time. This crosssectional study seeks to understand the differences in mental health outcomes among New Jersey Latinos by U.S. generation, demographic characteristics, and COVID-19 burden (e.g., disease infection, hospitalization, and death) among households, families, and workplace. Furthermore, this study examines the Latino Immigrant Paradox (i.e., foreign nativity protection against health and psychiatric disorders) for directional changes in resilience, illness prevalence, and health care and mental health service utilization during the COVID pandemic. The sample size was 156 Latino participants over the age of 18. Participants varied by U.S. generation, acculturation level, social and economic position, gender, and race/ethnicity. This study found four major findings. First, it found a directional change in the Latino Immigrant Paradox that related to depression levels and foreign nativity. Second, it uncovered that essential workers presented lower levels of depression compared to non-essential workers. Third, that COVID-19 burden did not impact the utilization of mental health services during the pandemic. Fourth, that nativity and language were greater predictors of mental health outcomes then were U.S. generations and acculturation levels.

Keywords: Latinx community, mental health, coronavirus pandemic (COVID-19), behavioral health, social determinants, acculturation, immigrant paradox